San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
J Clin Oncol. 2012 May 1;30(13):1447-55. doi: 10.1200/JCO.2011.39.5269. Epub 2012 Mar 26.
Because comorbidity affects cancer treatment outcomes, guidelines recommend considering comorbidity when making treatment decisions in older patients with lung cancer. Yet, it is unclear whether treatment is targeted to healthier older adults who might reasonably benefit.
Receipt of first-line guideline-recommended treatment was assessed for 20,511 veterans age ≥ 65 years with non-small-cell lung cancer (NSCLC) in the Veterans Affairs (VA) Central Cancer Registry from 2003 to 2008. Patients were stratified by age (65 to 74, 75 to 84, ≥ 85 years), Charlson comorbidity index score (0, 1 to 3, ≥ 4), and American Joint Committee on Cancer stage (I to II, IIIA to IIIB, IIIB with malignant effusion to IV). Comorbidity and patient characteristics were obtained from VA claims and registry data. Multivariate analysis identified predictors of receipt of guideline-recommended treatment.
In all, 51% of patients with local, 35% with regional, and 27% with metastatic disease received guideline-recommended treatment. Treatment rates decreased more with advancing age than with worsening comorbidity for all stages, such that older patients with no comorbidity had lower rates than younger patients with severe comorbidity. For example, 50% of patients with local disease age 75 to 84 years with no comorbidity received surgery compared with 57% of patients age 65 to 74 years with severe comorbidity (P < .001). In multivariate analysis, age and histology remained strong negative predictors of treatment for all stages, whereas comorbidity and nonclinical factors had a minor effect.
Advancing age is a much stronger negative predictor of treatment receipt among older veterans with NSCLC than comorbidity. Individualized decisions that go beyond age and include comorbidity are needed to better target NSCLC treatments to older patients who may reasonably benefit.
由于合并症会影响癌症的治疗效果，因此指南建议在为老年肺癌患者制定治疗决策时考虑合并症。然而，目前尚不清楚治疗是否针对身体状况更好、可能从中合理获益的老年患者。
从 2003 年至 2008 年，退伍军人事务部（VA）中央癌症登记处对年龄≥65 岁的 20511 例非小细胞肺癌（NSCLC）退伍军人的一线指南推荐治疗进行了评估。患者按年龄（65 至 74 岁、75 至 84 岁、≥85 岁）、Charlson 合并症指数评分（0、1 至 3、≥4）和美国癌症联合委员会分期（I 期至 II 期、IIIA 期至 IIIB 期、III B 期伴恶性胸腔积液至 IV 期）分层。合并症和患者特征来自 VA 索赔和登记数据。多变量分析确定了接受指南推荐治疗的预测因素。
局部疾病患者中 51%、局部疾病患者中 35%、转移性疾病患者中 27%接受了指南推荐的治疗。在所有分期中，随着年龄的增加，治疗率的下降幅度大于随着合并症的恶化，因此无合并症的老年患者的治疗率低于合并症严重的年轻患者。例如，局部疾病且年龄 75 至 84 岁且无合并症的患者中，有 50%接受了手术，而局部疾病且年龄 65 至 74 岁且合并症严重的患者中，有 57%接受了手术（P<0.001）。在多变量分析中，年龄和组织学仍然是所有分期治疗的强烈负预测因素，而合并症和非临床因素的影响较小。
在患有 NSCLC 的老年退伍军人中，年龄是比合并症更强的治疗接受情况的负预测因素。需要个体化的决策，不仅要考虑年龄，还要考虑合并症，以便更好地将 NSCLC 治疗针对可能从中合理获益的老年患者。
